Whitley House

Updated 19 May 2016

Whitley House surgery provides primary care services to a population of approximately 12300 patients in the Chelmsford area. The practice holds a General Medical Services (GMS) contract. The premises is purpose built and there is designated parking for the disabled on site.

The practice has three female and two male doctors, one nurse practitioner. three practice nurses and two health care assistants. There is also a practice manager, administration and reception staff.

The practice population is slightly higher than the national average for those of working age over thirty. Economic deprivation levels affecting children, older people and unemployment are lower than the practice average across England. Life expectancy for men and women are similar to the national averages. The practice patient list is similar to the national average for long standing health conditions and lower disability allowance claimants. The number of care home patients is comparable to national averages.

The surgery is open every day of the working week from 8am until 6.30p.m.There are early morning starts from 7am Tuesdays, Thursdays and Fridays to support commuters and working families. Telephone access is available from 8am. They offer both face-to-face and telephone appointments. Patients also have on line options to book appointments.

Emergency appointments are available throughout the day. The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by the NHS 111 service and patients who contact the surgery outside of opening hours are provided with information on how to contact the service. This information is also available on their own and the NHS choices website.

This practice has been accredited as a GP Training Practice and will have attached to it one or more qualified doctors training to specialise in General Practice.

Updated 19 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whitley House Surgery on 8 March 2016. Overall the practice is rated as good. The practice is rated as outstanding for the care of older people.

Our key findings across all the areas we inspected were as follows:

• Patients were protected from abuse and avoidable harm as staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Risks to patients were assessed and managed. Information about safety was monitored, appropriately reviewed and addressed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There were multi-disciplinary team discussions to ensure patients’ care and treatment was coordinated and data showed that the expected outcomes were comparable to other surgeries in the area.
• Patients said they were treated with compassion and dignity and they were involved in their care and decisions about their treatment. Information about services and how to complain was available and easy to understand.
• Patients said they could make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The premises were purpose built and maintained to an acceptable standard throughout the clinical areas. Access for disabled people was in place including parking for the disabled and washroom facilities.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• There was a leadership structure. Staff were appropriately qualified and competent to carry out their roles safely and effectively in line with best practice. Staff received satisfactory supervision and appraisal and were supported to undertake their continual professional development. Clinical staff and doctors were supported to participate in training and development which would enable them to deliver good effective quality care.

We saw one area of outstanding practice:

• We were told that Whitley House was the lead GP practice in Chelmsford for the 100 day Frailty Challenge set up as an initiative by the CCG involving six other GP practices as a pilot to improve care for frail patients. In the first three months of the initiative the reduction in avoidable admissions for that cohort of patients, was 17% and these practices have shown a 4% reduction from 14/15 to 15/16. This compares with a 9% increase for all other practice, so a very significant difference. This way of working, with enhanced multi disciplinary teams and the involvement of patients completing a narrative about themselves and their needs, has resulted in the initiative being extended into long term care and is including joint work between primary and secondary care. The CCG have also recognised that this initiative has improved relationships between GP practices and health and social care partners.

The areas where the provider should make improvement are:

• Ensure that the system for checking the medicines carried by GPs when away from the practice is more robustly monitored. Ensure that there is an effective system for documenting the control of stock in relation to vaccines in use at the practice and their expiry dates. Ensure records of these checks are recorded.

• Ensure that all staff are aware of the issues affecting the practice including the objectives, performance and the learning from significant events and safety incidents.

• Ensure policies are up to date and reflect current practice.

• Improve the identification of patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 May 2016

The practice is rated as good for the care of people with long-term conditions.

• Patients with long term conditions had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Doctors and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Chronic disease reviews were offered in the surgery or at home if the patient is housebound. Diabetes Protocols were followed with support from the Diabetes lead doctor and COPD/Asthma annual reviews and follow up appointments were actioned with a trained Asthma Nurse.

• A recall system was in place to ensure continuity of care for all disease management of long term conditions, together with medication reviews and follow up checks as and when required or requested. There were anti coagulation blood testing and dosing clinics provided by the practice nurse for people with blood clotting disorders.

Updated 19 May 2016

The practice is rated as good for the care of families, children and young people.

• The surgery offered appointments at various times during the day starting at 7am. Sit and wait surgeries for the later morning had been introduced and these were extended if demand required it. The duty doctor system ensured same day access for any urgent phone enquiries or patients needing same day assessment.

• The GPs were involved in both antenatal and post-natal care to keep continuity of care for families and the ongoing relationship with the new child and mother. They liaised with the midwife who attended the surgery for weekly clinics.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Children on the at risk register had a named GP and the practice had an open door policy for children if a parent requests a same day appointment.

• Childhood immunisation programme was offered with follow up to patient’s parents/carers if appointment is not attended. Immunisation rates were comparable with the CCG for all standard childhood immunisations.

Updated 19 May 2016

The practice is rated as outstanding for the care of older people.

• Whitley House was the lead GP practice in Chelmsford for the 100 day Frailty Challenge set up as an initiative by the CCG involving six other GP practices as a pilot to improve care for frail patients. In the first three months of the initiative the reduction in avoidable admissions for that cohort of patients, was 17% and these practices have shown a 4% reduction from 14/15 to 15/16. This compares with a 9% increase for all other practice, so a very significant difference This way of working, with enhanced multi disciplinary teams and the involvement of patients completing a narrative about themselves and their needs, has resulted in the initiative being extended into long term care and is including joint work between primary and secondary care. The CCG have also recognised that this initiative has improved relationships between GP practices and health and social care partners.

• The practice offered responsive, proactive, personalised care to meet the needs of the older people in its population. Nationally reported data showed that outcomes for patients were comparable for conditions commonly found in older people.

• The surgery offered senior health checks for all those over 75 years and they all had a named GP. The practice offered home visits and urgent appointments for those with enhanced needs.

• The GPs reviewed all registered care home residents six monthly and liaised closely with care staff, relatives and carers regarding advanced care planning to ensure patient’s wishes were acted on.

• Telephone appointments and home visits were available for those who were unable to get to the surgery. A carer’s register highlighted those who cared for a loved one and who may need support and advise.

• GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for patients at risk, including those with dementia and those receiving end of life palliative care.

• The surgery had links with a community agent who provides social and economic advice and support to older people in their homes.

Updated 19 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered early morning appointments which were pre bookable and commenced at 7am, three days per week.

There were also telephone triage appointments and double appointments available where necessary.

• The practice was proactive in offering online services including the booking of appointments and repeat prescriptions were able to be ordered on line as well as a full range of health promotion and screening that reflected the needs for this age group, such as Health Trainers and Walking for Health support programmes.

• Patients were aware of SMS text messaging services and were complimentary about the flexible consultative approach of the practice.

Updated 19 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice was working towards becoming a "Dementia friendly practice" following an initial meeting in January 2016 with the Alzheimer’s Society. There was a forum to discuss best care for dementia patients and their carers. All carers were offered the opportunity to be coded on their notes as "carers" so opportunistic health screening could take place for them..

• All mental health and dementiapatients were offered individual care plans and any appropriate advanced care planning (IAM forms). All were invited to annual physical health reviews and the surgery followed up and called any non-attenders to encourage compliance. 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to other practices.

• The practice offered annual checks, extended appointments and regular telephone appointments for patients experiencing poor mental health. Advice was provided about how to access various support groups and voluntary organisations. Systems were in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 19 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people to ensure that patients whose circumstances made them vulnerable were supported holistically. The practice offered annual health checks for patients with learning disabilities. There was a specifically modified recall system and letters to encourage attendance with the practice nurse who had links with the local learning disability lead nurse and team to ensure best practice and utilising local resources.

• The practice carried out home visits to undertake health reviews as needed and offered longer appointments for vulnerable patients. They saw all those registered at the local homeless centre and temporary registration was encouraged along with NHS screening and health checks to improve health outcome for this vulnerable group.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.